WO1987006478A1 - Systematized treatment instrument, using particularly laser energy, useful for example in dermatology - Google Patents

Systematized treatment instrument, using particularly laser energy, useful for example in dermatology Download PDF

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Publication number
WO1987006478A1
WO1987006478A1 PCT/FR1987/000139 FR8700139W WO8706478A1 WO 1987006478 A1 WO1987006478 A1 WO 1987006478A1 FR 8700139 W FR8700139 W FR 8700139W WO 8706478 A1 WO8706478 A1 WO 8706478A1
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WO
WIPO (PCT)
Prior art keywords
optical fiber
treatment instrument
instrument according
laser
elementary
Prior art date
Application number
PCT/FR1987/000139
Other languages
French (fr)
Inventor
Bruno Buys
Jean-Pierre Sozanski
Serge Mordon
Jean-Marc Brunetaud
Yves Moschetto
Original Assignee
Institut National De La Sante Et De La Recherche M
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Institut National De La Sante Et De La Recherche M filed Critical Institut National De La Sante Et De La Recherche M
Priority to DE8787902557T priority Critical patent/DE3781506T2/en
Priority to AT87902557T priority patent/ATE80050T1/en
Publication of WO1987006478A1 publication Critical patent/WO1987006478A1/en

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Classifications

    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B23—MACHINE TOOLS; METAL-WORKING NOT OTHERWISE PROVIDED FOR
    • B23K—SOLDERING OR UNSOLDERING; WELDING; CLADDING OR PLATING BY SOLDERING OR WELDING; CUTTING BY APPLYING HEAT LOCALLY, e.g. FLAME CUTTING; WORKING BY LASER BEAM
    • B23K26/00—Working by laser beam, e.g. welding, cutting or boring
    • B23K26/08—Devices involving relative movement between laser beam and workpiece
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
    • A61B18/203—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser applying laser energy to the outside of the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/06—Radiation therapy using light
    • A61N5/067—Radiation therapy using light using laser light
    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B23—MACHINE TOOLS; METAL-WORKING NOT OTHERWISE PROVIDED FOR
    • B23K—SOLDERING OR UNSOLDERING; WELDING; CLADDING OR PLATING BY SOLDERING OR WELDING; CUTTING BY APPLYING HEAT LOCALLY, e.g. FLAME CUTTING; WORKING BY LASER BEAM
    • B23K26/00—Working by laser beam, e.g. welding, cutting or boring
    • B23K26/02—Positioning or observing the workpiece, e.g. with respect to the point of impact; Aligning, aiming or focusing the laser beam
    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B23—MACHINE TOOLS; METAL-WORKING NOT OTHERWISE PROVIDED FOR
    • B23K—SOLDERING OR UNSOLDERING; WELDING; CLADDING OR PLATING BY SOLDERING OR WELDING; CUTTING BY APPLYING HEAT LOCALLY, e.g. FLAME CUTTING; WORKING BY LASER BEAM
    • B23K26/00—Working by laser beam, e.g. welding, cutting or boring
    • B23K26/08—Devices involving relative movement between laser beam and workpiece
    • B23K26/082—Scanning systems, i.e. devices involving movement of the laser beam relative to the laser head
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00022—Sensing or detecting at the treatment site
    • A61B2017/00057—Light
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00743—Type of operation; Specification of treatment sites
    • A61B2017/00747—Dermatology
    • A61B2017/00756—Port wine stains
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00452—Skin
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
    • A61B2018/2035—Beam shaping or redirecting; Optical components therefor
    • A61B2018/20351—Scanning mechanisms
    • A61B2018/20357—Scanning mechanisms by movable optical fibre end

Definitions

  • the invention relates to a systemized treatment instrument. It will in particular find its application in the medical field such as in dermatology for the treatment of angiomas.
  • Planar angioma better known as "wine stain * , has
  • the laser technique is generally used by the practitioner who obtains the obturation of blood vessels manually by photocoagulation using a laser of the
  • the Argon laser presents radiation adapted to the treatment of plane angiomas because it is well absorbed by living tissue with a preferential action in terms of red and black pigments. This is why we often use the thermal effects of
  • the desired thermal effects are a temperature between 60 and 80 ° C which must be limited to micro-vessels of the dermis to prevent tissue necrosis resulting scar risks.
  • the skill of the practitioner is essential because it is he who masters all the parameters of the treatment, namely the power of the radiation, the exposure time, the relative positioning of the different impacts and the uniformity of these impacts.
  • angiomas occupy most of the time large surfaces of the order of several square centimeters which are not always plane and since the diameter of the elementary laser spots at the level of the impacts is of the order of a millimeter, the implementation of the treatment will force the practitioner to manually juxtapose several hundred shots without practically 25 " no positioning reference.
  • the aim of the present invention is to propose a systematized treatment instrument which can be used in particular in dermatology for the treatment of angiomas, which makes it possible to take over from the skill of the practitioner by controlling each of the parameters necessary for treatment and the setting of which work faster to reduce processing time.
  • One of the aims of the present invention is to propose a systematized treatment instrument, which makes it possible to significantly increase the percentage of success of the treatment of angiomas compared to the methods currently known.
  • Another object of the present invention is to propose a systematized treatment instrument which allows the treatment of angiomas by perfectly known and reproducible geometric zones and which, by a single positioning of the instrument, - - _ ideally and efficiently treats surface areas up to 2.6 cm while the optical fiber used generally only allows an elementary spot of about 1 mm in diameter.
  • Another object of the present invention is to propose a systematized treatment instrument, in particular usable in dermatology for the treatment of planar angiomas, which makes it possible to control the thermal parameters by controlling the power of irradiation, the distance from the impact instrument, the time d 'exposure and which simultaneously makes it possible to master the geometric parameters', namely the uniformity of the elementary spots and their precise juxtaposition in a contiguous manner.
  • Another object of the present invention is to propose a systematized treatment instrument which makes it possible to overcome the thermal relaxation time created by the diffusion of heat at the level of the impact and consequently to avoid any temperature overload.
  • Another object of the present invention is to propose a systematized treatment instrument which can be used in particular in dermatology for the treatment of angiomas, which by a programmed sequential scanning mode allows consecutive laser shots whose impacts are not contiguous while performing a final juxtaposition of said impacts very precise and contiguous to cover the entire area of the body under investigation.
  • the systematized treatment instrument comprising means for treating an area of a body, in particular usable in dermatology for the treatment of angiomas, the said instrument being in particular connected to a source of laser radiation and having a frame in which is also arranged an optical fiber making it possible to transmit the laser energy and to form an elementary spot at the level of the impact with the zone under investigation, is characterized by the fact that it comprises: on the one hand means for relative positioning of the optical fiber with respect to the area of the body under investigation, and on the other hand means for sequential scanning of said area which make it possible to control the position of the optical fiber and the consequent elementary spot as well as the final juxtaposition of the different contiguous impacts by optimizing the order of distribution of the laser shots so that at least during two consecutive laser shots, the consequent elementary spots are not contiguous to avoid the thermal accumulation effects of the previous impact.
  • FIG. 1 represents a schematic perspective view of an embodiment of the systemized processing instrument of the present invention which makes it possible to illustrate the principle of operation thereof.
  • FIG. 2 shows a preferential arrangement of the unitary treatment zones formed by the juxtaposition of contiguous elementary spots according to the present invention.
  • Figure 3 is a sectional view of a more detailed embodiment of a systematized treatment instrument produced according to the invention.
  • Figure 4 shows a partial schematic view from below of the instrument shown in Figure 3 which shows the modularity of the unit area treated.
  • FIG. 5 illustrates a scanning mode of the optical fiber of the processing instrument of the present invention allowing a sequence of consecutive and contiguous elementary spots.
  • FIG. 6 represents another preferred scanning mode which illustrates a sequence of consecutive laser shots forming consequent elementary spots not contiguous, however the final juxtaposition then having contiguous impacts.
  • FIG. 7 shows a detailed view of the processing instrument of the present invention which illustrates its dialogue and display means.
  • FIG. 8 shows a possible implantation of the systemized treatment instrument of the present invention on a bracket so as to facilitate its use by the practitioner.
  • the present invention relates to a systemized treatment instrument whose major application will be medical, in particular in - ⁇ - dermatology for the treatment of plane angiomas.
  • body is to be taken in its broad sense, that is to say that it can be formed by living tissue or by any other inert material.
  • area under investigation identified 2 in the figures, it is meant the unit surface which is subjected to the effects of the systemized treatment instrument of the invention during positioning.
  • the systematized treatment instrument of the present invention comprises means for treating an area of a body which will use the thermal effects of a laser source in order to obtain, in the case of planar angiomas, the obturation of the vessels. dermal blood cells by photocoagulation.
  • angioma which generally occupies a large area of the order of several square centimeters, the maximum size of the elementary area 2 to be treated will therefore be voluntarily limited for these reasons.
  • an angioma can have in the three dimensions a very tormented and varied cartography, as for example in the case of a cheek and wing of the nose. We will therefore limit the size of the unit area 2 so that we can consider the flat treated surface to preserve a constant shooting distance. This will also reduce the patient's downtime to reasonable values less than one minute.
  • the systematized treatment instrument 1 therefore makes it possible to meet the abovementioned objectives and to automate the treatment in a reliable and controlled manner inside a unitary surface 2.
  • FIGS. 1 and 3 respectively illustrate the principle and a detailed preferred embodiment of the present invention.
  • the systematized treatment instrument 1 is formed around a frame 3 formed by an apparatus support plate 51 and a bracket 20 and serving as support for the various constituents. More precisely, in this frame is also arranged an optical fiber 5 making it possible to transmit the laser energy and finally to form an elementary spot 6 at the level of the impact with the area under investigation 2. For this instrument the instrument is notably connected to a source of laser radiation, not shown, connection marked with •, in the figures.
  • the optical fiber 5 will advantageously be at least immobilized at a fixed point 7 of the frame 3 which will include a centering and immobilization system 8 of the cable gland type. Furthermore, the end 9 of the optical fiber 5, mounted on the frame 3, which can constitute a source of mobile laser radiation of low inertia is placed opposite a focusing optic 10, the optical fiber assembly 5 and focusing optics 10 then defining an optical main axis 11. As regards the actual production of the focusing optics 10, it will form an objective consisting of two convex planar lenses 12, 13 forming a symmetrical doublet according to conventional techniques centered on the main axis * •. . The doublet is immobilized axially and secured to the frame 3 by the mount 14.
  • the treatment instrument 1 essentially comprises, on the one hand, means of positioning 15 relative to the optical fiber 9 with respect to the area of the body under investigation 2, and on the other hand sequential scanning means 16 of said area under investigation which make it possible to control the position of the end of the optical figure 9 and of the consequent elementary spot 6 as well as the final juxtaposition of the different contiguous impacts 17 formed by optimizing the order of distribution of the laser shots so that at least during two consecutive laser shots the elementary spots 6 consequent are not contiguous in order to avoid the effects of thermal accumulation of the previous impact.
  • the sequential scanning means 16 are constituted by a mechanical device sequentially moving the end 9 of the optical fiber 5 in a plane 50 perpendicular to the main optical axis 11 in order to generate the displacement and the identified positioning of the elementary spot 6 over the entire unit surface under investigation 2 this in particular by 1 through the aforementioned focusing optics 10.
  • the sequential scanning means 16 are constituted by a mechanical device sequentially moving the end 9 of the optical fiber 5 in a plane 50 perpendicular to the main optical axis 11 in order to generate the displacement and the identified positioning of the elementary spot 6 over the entire unit surface under investigation 2 this in particular by 1 through the aforementioned focusing optics 10.
  • the mechanical device generating this biaxial movement is formed in particular by two crank rod systems 18 and 19, both integral with the frame .3 and mounted on the plate 51; a fixed system is therefore formed relative to the frame 3, the fixed point 7 of the optical fiber and the crank rods 18 and 19 being joined by means of a bracket 20.
  • the two crank-rod systems 18 and 19 are each driven by a motor member 21 and 22 respectively cooperating with each other at the ends of each connecting rod, respectively marked 23 and 24, to form a common articulation 25 to which the end 9 of the optical fiber 5 is secured.
  • the drive members 21, 22 of each rod-crank system 18, 19 are controlled independently and their rotation is controlled to generate the sequential scanning by the mobile end 9 of the optical fiber of the entire surface corresponding to the unitary processing surface 2.
  • the figure of the path of displacements has the form of a pseudo-diamond 28 whose sides are portions of a circle. It should be noted that in this form, it is possible in particular to circumscribe a hexagon 29 formed by all of the positions actually used.
  • this system will be such that the optical requirements are met and in particular it will be ensured that a portion of the end 9 of the optical fiber 5 is substantially parallel to the optical axis 11 for this, the articulation will advantageously be split. 25 as shown in FIGS. 1 and 3. In addition, it will also be ensured that the bending imposed on the optical fiber does not is not harmful to avoid mechanical fatigue as well as optical losses.
  • the sequential scanning means 16 form an isostatic structure in which the optical fiber plays the role of a moving assembly with respect to the frame 3.
  • the drive members 21 and 22 are in the form of a "stepper" motor supplied by predetermined analog current levels making it possible to divide the “steps standard "motors in several" micro-steps "to increase positioning accuracy.
  • the main steps are divided linearly into 32 micro-steps resulting in a positioning resolution of 0.02 mm referred to the elementary spots of 1 mm which will allow a resolution that is largely sufficient in the application of the treatment considered .
  • each rod-crank system 18, 19 is slaved to a position sensor, respectively marked 30, 31 authorizing a periodic initialization of the positioning of the drive members 21, 22.
  • the sensors used will be fixed position sensors with respect to the frame 3 and positioned opposite an index disposed on the cranks 26, 27.
  • this set of sensors does not require any precision because it only locates positions corresponding to each repeated sequence, for example every four steps because in this case we find an identical electrical state for the motor.
  • this set of spacers 33 will have adjustment means 34 to adapt the shooting distance to the desired value 11T.
  • adjustment means 34 to adapt the shooting distance to the desired value 11T.
  • an independent adhesive support may be provided, not shown, previously applied to the epidermis of the patient, this support comprising visible positioning marks adapted to the geometric shape of the unit surface 2.
  • the set of spacers 33 will advantageously have a cut window at the dermis, which will facilitate this positioning with respect to adhesive marking.
  • the irradiation power of the laser source is controlled and in this regard the processing instrument 1 has means for measuring the power of the emitted laser radiation. 2.5 These means of measurement are based on the principle of the integrating sphere which is a faithful method of indirect measurement of total radiated power.
  • the mount 14 will be made such that all of the surfaces of the cavity are reflecting and diffusing specific radiation from the laser. Part of the total scattered radiation is sampled and measured by a photoelectric sensor 37 which will advantageously be fitted with a filter adapted to the laser.
  • the optical fiber 5 will be positioned during the measurement coaxial to the axis. main optic 11 and the actual measurement will be performed and processed by techniques within the reach of ordinary skill in the art.
  • the latter comprises shutter means 38 controlled and synchronized with said scanning means 16 for controlling the exposure time of each regardless of the operating conditions of the laser source.
  • the shutter 38 consists of a 3 " 9f pallet, angularly movable on an axis 40 parallel to the main optical axis 11. It is driven by a mechanical system with a lever arm by an electromagnet 41 by example. Such an embodiment is notably known to a person skilled in the art.
  • the obturation plan was chosen in a privileged afocal zone constituted by the pseudo-focus of the beams generated by the diaphragm nature of the object source.
  • the pallet is made of diffusing reflective material such as aluminum alloy.
  • the instrument 1 of the present invention comprises an automatic control unit of the said instrument organized around a central electronic unit, of a time base and additional circuits which also allow the control of the scanning means, the measurement of the power of the irradiation, the control of the synchronized shutter means, the dialogue with the operator.
  • control circuit of the scanning means comprises at least one memory into which data are entered in order to authorize a laser firing sequence to cover by their impacts 17 a geometric figure 29 by juxtaposition of elementary spots 6 contiguous perfectly reproducible over time.
  • the figure Geometrically advantageously takes the form of a regular hexagon, their mutual joining being perfect by six different axes at 60 degrees.
  • the hexagon is the geometric continuity of the basic triangle formed by three circular spots 6 5 contiguous to each other.
  • control electronics are designed such that
  • the surface of the geometrical figure is modular as shown in particular in Figure 4.
  • One of the original aspects of the present invention relates to the order of automatic distribution of the laser shots in order to completely cover at the end of a shooting sequence the unit surface of the area under investigation 2 by a contiguous juxtaposition of the
  • FIG. 6 shows a sequential scanning order by which, the elementary spots 6 having a substantially similar diameter by one millimeter, the successive spots are then always at least two millimeters apart. This makes it possible to use firing repetition times with an average value of 140 milliseconds and consequently considerably reduce the time for processing an elementary surface 2.
  • the automatic control unit of the system and its control circuit of the scanning means are programmed by software which makes it possible to locate on the abscissa and on the ordinate the different positions of the elementary spots 6 and to move the optical fiber to this regard by controlled rotations of the drive members 21 and 22 of the scanning system 16.
  • This illustrated scanning mode is entirely arbitrary and other scanning modes could be envisaged by different programming.
  • the control unit includes means for canceling the sequential scanning of laser shots forming disjoint spots to authorize either an automatic scanning of consecutive contiguous spots as shown in FIG. 5 or a traditional manual scanning.
  • the practitioner has a display and control panel 42, as shown in FIG. 7, which will advantageously be separated from the treatment instrument. 1 itself in order to avoid too much space. It is the same also for the location of the aforementioned control unit.
  • This control panel 42 will make it possible, for example, to have test indicators of the internal functioning of the system at 43, control the power measurement by a display at 44, control the exposure time and enter this data at 45, select the type of scan and choose the extent of the treatment field at 46.
  • test indicators of the internal functioning of the system at 43 control the power measurement by a display at 44, control the exposure time and enter this data at 45, select the type of scan and choose the extent of the treatment field at 46.
  • the treatment instrument 1 of the present invention will advantageously be supported by the arrow 48 of a bracket 47, the electronic central unit and the control panel 42 being arranged on the mast of the gallows 47, in particular at 49 in FIG. 8.
  • the electronic central unit and the control panel 42 being arranged on the mast of the gallows 47, in particular at 49 in FIG. 8.

Abstract

The invention relates to a systematized treatment instrument and is particularly applicable to the medical field and more particularly in dermatology for the treatment of engiomas simplex. The systematized treatment instrument (1) comprises means for the treatment of a region of a body (2) and is connected at (4) to a laser beam source. It has a frame (3) wherein there is arranged an optical fiber (5) for the transmission of laser energy and for the formation of an elementary spot (6) at the impact with the area being treated (2). According to the invention it comprises on the one hand means for the relative positioning (15) of the optical fiber (5) with respect to the area of the body being treated (2) and on the other hand means for the sequential scanning (16) of said area which enable to control the position of the optical fiber (9) and of the resulting elementary spot (6) as well as the final juxtaposition of different contiguous impacts by optimalizing the distribution order of laser shots so that, at least upon two consecutive laser shots, the resulting elementary spots (6) are not contiguous in order to avoid the thermal accumulation effects of the preceeding impact.

Description

Titre : Instrument de traitement systématisé, utilisant notamment l'énergi laser, utile par exemple en dermatologie. Title: Systematic treatment instrument, using in particular laser power, useful for example in dermatology.
L'invention est relative à un instrument de traitement systématisé. Elle trouvera notamment son application dans le domaine médical tel qu'en dermatologie pour le traitement des angiomes.The invention relates to a systemized treatment instrument. It will in particular find its application in the medical field such as in dermatology for the treatment of angiomas.
L'angiome plan, plus connu sous le nom "tache de vin*, aPlanar angioma, better known as "wine stain * , has
5 pour origine une hypervascularisation du derme qui donne un effet inesthétique et disgracieux au niveau de la peau du sujet.5 originates from hypervascularisation of the dermis which gives an unsightly and unsightly effect on the subject's skin.
Actuellement, il est connu des méthodes de traitement de l'angiome plan qui consistent à obturer les vaisseaux sanguins au niveau de la zone concernée du derme de façon à obtenir uneCurrently, methods of treating angioma planis are known, which consist in closing the blood vessels in the concerned area of the dermis so as to obtain a
13. décoloration permanente de la lésion sans provoquer pour autant d'autres effets secondaires.13. permanent discoloration of the lesion without causing other side effects.
De nos jours, la technique du laser est généralement utilisé par le praticien qui réalise l'obturation des vaisseaux sanguins manuellement par photocoagulation à l'aide d'un laser duNowadays, the laser technique is generally used by the practitioner who obtains the obturation of blood vessels manually by photocoagulation using a laser of the
15 type Argon par exemple.15 Argon type for example.
En «effet, le laser Argon présente un rayonnement adapté aux traitements des angiomes plans car il est bien absorbé par les tissus vivants avec une action préférentielle au niveau des pigments rouges et noirs. C'est pourquoi on utilise souvent les effets thermiques duIn effect, the Argon laser presents radiation adapted to the treatment of plane angiomas because it is well absorbed by living tissue with a preferential action in terms of red and black pigments. This is why we often use the thermal effects of
20 laser Argon pour le traitement de tels symptômes.20 Argon laser for the treatment of such symptoms.
Dans le cas du traitement des angiomes, les effets thermiques souhaités sont une température comprise entre 60 et 80 *C qui doit être limitée aux micro-vaisseaux du derme afin d'éviter toute nécrose tissulaire entraînant des risques cicatriciels.In the case of treatment of hemangiomas, the desired thermal effects are a temperature between 60 and 80 ° C which must be limited to micro-vessels of the dermis to prevent tissue necrosis resulting scar risks.
2_r Actuellement, ce procédé de traitement est mis en oeuvre manuellement par le praticien qui, au moyen d'une source laser Argon munie d'un obturateur atténuateur commandé pour régler le temps d'irradiation et par l'intermédiaire d'une fibre optique transmettant l'énergie laser, effectue des tirs laser pour former2_r Currently, this treatment process is implemented manually by the practitioner who, by means of an Argon laser source provided with an attenuator shutter controlled to regulate the irradiation time and by means of an optical fiber transmitting laser energy, laser shots to form
30 une multitude d'impacts voisins au niveau de la zone à traiter.30 a multitude of neighboring impacts in the area to be treated.
Dans ce cas l'habileté du praticien est primordiale car c'est lui qui maitrise tous les paramètres du traitement à savoir la puissance du rayonnement, le temps d'exposition, le positionnement relatif des différents impacts et l'uniformité de ces impacts.In this case the skill of the practitioner is essential because it is he who masters all the parameters of the treatment, namely the power of the radiation, the exposure time, the relative positioning of the different impacts and the uniformity of these impacts.
35 Le succès du traitement dépend donc essentiellement du praticien et de son habileté à maitriser ces paramètres qui peuvent déterminer des effets thermiques très variés tant par la température atteinte qui entraine soit une coagulation soit une volatilisation, que par la localisation de cette élévation de température.35 The success of the treatment therefore essentially depends on the practitioner and his ability to master these parameters which can determine very varied thermal effects both by the temperature reached which causes either coagulation or volatilization, only by the location of this rise in temperature.
De plus, à ces paramètres, vient s'ajouter un élément supplémentaire directement lié à la puissance de l'impact réalisé, il s'agit d'un effet de diffusion thermique autour de l'impact réaliséIn addition, to these parameters, there is an additional element directly related to the power of the impact achieved, it is a thermal diffusion effect around the impact achieved
5 qui provoque une accumulation thermique qu'il faudra également maitriser.5 which causes thermal accumulation which will also have to be controlled.
Par ailleurs, le praticien n'ayant d'autres moyens de repérage des impacts que le positionnement d'un nouvel impact par r-appu-C-fc à celui qui vient d'être réalisé ceci afin de juxtaposer les 10. impacts: de façon contigue, le phénomène de diffusion thermique oblige le praticien à effectuer l'impact suivant contigu qu'après un certain temps de relaxation pour éviter de prendre en compte les effets d'accumulation thermique et par conséquence éviter une surcharge en température. 15 . Ces différents paramètres pris en considération font que l'efficacité actuelle du traitement représente environ 50 à 60 Z de succès et obligent les patients à faire appel à des praticiens très expérimentés car le succès en est essentiellement dépendant.In addition, the practitioner having no other means of identifying impacts than positioning a new impact by r-appu-C-fc to that which has just been carried out in order to juxtapose the 10. impacts: contiguously, the phenomenon of thermal diffusion obliges the practitioner to carry out the following contiguous impact only after a certain time of relaxation to avoid taking into account the effects of thermal accumulation and consequently avoid an overload in temperature. 15. These various parameters taken into account mean that the current efficacy of the treatment represents approximately 50 to 60% of success and oblige patients to call on very experienced practitioners because success is essentially dependent on it.
De plus, les angiomes occupent la plupart du temps des 20 surfaces importantes de l'ordre de plusieurs centimètres carrés qui ne sont pas toujours planes et étant donné que le diamètre des spots laser élémentaires au niveau des impacts est de l'ordre du millimètre, la mise en oeuvre du traitement obligera le praticien à juxtaposer manuellement plusieurs centaines de tirs sans pratiquement 25" aucune référence de positionnement.In addition, angiomas occupy most of the time large surfaces of the order of several square centimeters which are not always plane and since the diameter of the elementary laser spots at the level of the impacts is of the order of a millimeter, the implementation of the treatment will force the practitioner to manually juxtapose several hundred shots without practically 25 " no positioning reference.
En effet, du fait de la technique mise en oeuvre, le praticien est soumis au port de lunettes de protection et ainsi il ne perçoit que faiblement le spot qu'il positionne. Ceci rend également difficile l'uniformité des diamètres des spots effectués qui dépend 0 essentiellement de la distance de la fibre optique par rapport à la - zone sous investigation.Indeed, due to the technique used, the practitioner is subject to wearing protective glasses and thus he perceives only faintly the spot which he positions. This also makes it difficult to achieve uniformity in the diameters of the spots made, which essentially depends on the distance of the optical fiber from the area under investigation.
Le cumul de ces impératifs fait de ce procédé de traitement un procédé délicat et fastidieux à mettre en oeuvre qui de plus doit être fractionné en plusieurs séances pour ménager d'une part le 5 patient qui doit être immobile pendant le traitement et d'autre part le praticien qui doit soutenir une attention accrue.The combination of these imperatives makes this treatment process a delicate and tedious process to be implemented which, moreover, must be divided into several sessions to spare the patient on the one hand who must be stationary during the treatment and on the other hand the practitioner who must support increased attention.
Pour pallier aux échecs dans les résultats de cette thérapeutique et pour faciliter le travail du praticien, il a été envisagé d'automatiser sa tâche en robotisant l'intervention.To overcome the failures in the results of this therapy and to facilitate the work of the practitioner, it was envisaged automating his task by robotizing the intervention.
En effet, il a été présenté il y a quelques années une installation de traitement constituée essentiellement par un bras robotisé effectuant' le déplacement contrôlé d'une pièce à main dans laquelle est disposée la fibre optique.Indeed, it was presented a few years ago an essentially constituted by a robotic arm processing facility performing 'the controlled displacement of a handpiece in which is disposed the optical fiber.
Cette méthode n'a jusqu'à présent fait l'objet d'aucun développement car sa mise en oeuvre est délicate car elle suppose une reconnaissance de formes tridimensionnelles et ne prend pas en compte notamment les mouvements du patient en cours de traitement. Une telle installation facilite l'intervention du praticien mais donne des résultats qui sont inférieurs à ceux obtenus par la méthode traditionnelle manuelle.This method has not hitherto been the subject of any development since its implementation is delicate since it presupposes recognition of three-dimensional shapes and does not in particular take into account the movements of the patient during treatment. Such an installation facilitates the intervention of the practitioner but gives results which are lower than those obtained by the traditional manual method.
D'autre part, il est également connu un instrument à main, réalisé sur le même principe que le dispositif précité, positionné par le praticien, c'est-à-dire à l'aide d'une fibre optique incluse dans un boitier portatif transmettant l'énergie d'une source laser, mais dont le spot élémentaire a été élargi en utilisant une optique anamorphique.On the other hand, there is also known a hand instrument, produced on the same principle as the aforementioned device, positioned by the practitioner, that is to say using an optical fiber included in a portable case. transmitting the energy of a laser source, but whose elementary spot has been widened using an anamorphic optics.
Toutefois, avec cet instrument, l'uniformité du spot est difficile à obtenir, et de plus la profondeur de champ est très réduite. Par ailleurs, pour respecter les paramètres de traitement précités, il est fait appel à une source laser de forte puissance ce qui handicap son développement en augmentant le coût de revient d'un tel système. Le .but de la présente invention est de proposer un instrument de traitement systématisé notamment utilisable en dermatologie pour le traitement des angiomes, qui permette de prendre le relais de l'habileté du praticien en contrôlant chacun des paramètres nécessaires au traitement et dont la mise en oeuvre soit plus rapide pour réduire le temps de traitement.However, with this instrument, uniformity of the spot is difficult to obtain, and moreover the depth of field is very reduced. Furthermore, in order to comply with the aforementioned treatment parameters, use is made of a high power laser source which handicaps its development by increasing the cost price of such a system. The aim of the present invention is to propose a systematized treatment instrument which can be used in particular in dermatology for the treatment of angiomas, which makes it possible to take over from the skill of the practitioner by controlling each of the parameters necessary for treatment and the setting of which work faster to reduce processing time.
Un des buts de la présente invention est de proposer un instrument de traitement systématisé, qui permette d'augmenter sensiblement le pourcentage de réussite du traitement des angiomes par rapport aux méthodes connues actuellement. Un autre but de la présente invention est de proposer un instrument de traitement systématisé qui permette le traitement des angiomes par zones géométriques parfaitement connues et reproductibles et qui, par un seul positionnement de l'instrument, - - _ traite idéalement et efficacement des zones de surface allant jusque 2,6 cm alors que la fibre optique utilisée n'autorise généralement qu'un spot élémentaire d'environ 1 mm de diamètre.One of the aims of the present invention is to propose a systematized treatment instrument, which makes it possible to significantly increase the percentage of success of the treatment of angiomas compared to the methods currently known. Another object of the present invention is to propose a systematized treatment instrument which allows the treatment of angiomas by perfectly known and reproducible geometric zones and which, by a single positioning of the instrument, - - _ ideally and efficiently treats surface areas up to 2.6 cm while the optical fiber used generally only allows an elementary spot of about 1 mm in diameter.
Un autre but de la présente invention est de proposer un instrument de traitement systématisé, notamment utilisable en dermatologie pour le traitement des angiomes plans, qui permette de maitriser les paramètres thermiques en contrôlant la puissance d'irradiation, la distance instrument impact, le temps d'exposition et qui simultanément permette de maitriser les paramètres ' géométriques à savoir l'uniformité des spots élémentaires et leur juxtaposition précise de façon contigue.Another object of the present invention is to propose a systematized treatment instrument, in particular usable in dermatology for the treatment of planar angiomas, which makes it possible to control the thermal parameters by controlling the power of irradiation, the distance from the impact instrument, the time d 'exposure and which simultaneously makes it possible to master the geometric parameters', namely the uniformity of the elementary spots and their precise juxtaposition in a contiguous manner.
Un autre but de la présente invention est de proposer un instrument de traitement systématisé qui permette de s'affranchir du temps de relaxation thermique crée par la diffusion de la chaleur au niveau de l'impact et par suite d'éviter toute surcharge en température.Another object of the present invention is to propose a systematized treatment instrument which makes it possible to overcome the thermal relaxation time created by the diffusion of heat at the level of the impact and consequently to avoid any temperature overload.
Un autre but de la présente invention est de proposer un instrument de traitement systématisé notamment utilisable en dermatologie pour le traitement d'angiomes, qui par un mode de balayage séquentiel programmé autorise des tirs laser consécutifs dont les impacts ne soient pas contigus tout en effectuant une juxtaposition finale des dits impacts très précise et contigue pour couvrir toute la zone du corps sous investigation.Another object of the present invention is to propose a systematized treatment instrument which can be used in particular in dermatology for the treatment of angiomas, which by a programmed sequential scanning mode allows consecutive laser shots whose impacts are not contiguous while performing a final juxtaposition of said impacts very precise and contiguous to cover the entire area of the body under investigation.
O'autres buts et avantages de la présente invention : apparaitront au cours de la description qui va suivre qui n'est cependant donnée qu'à titre indicatif et qui n'a pas pour but de la limiter.O'autres aims and advantages of the present invention: will appear during the description which follows which is however given only as an indication and which is not intended to limit it.
Selon la présente invention, l'instrument de traitement systématisé, comprenant des moyens de traitement d'une zone d'un corps, notamment utilisable en dermatologie pour le traitement des angiomes, le dit instrument étant notamment connecté à une source de rayonnement laser et présentant un bâti dans lequel est disposée en outre une fibre optique permettant de transmettre l'énergie laser et de former un spot élémentaire au niveau de l'impact avec la zone sous investigation, est caractérisé par le fait qu'il comporte : d'une part des moyens de positionnement relatif de la fibre optique vis-à-vis de la zone du corps sous investigation, et d'autre part des moyens de balayage séquentiel de la dite zone qui permettent de contrôler la position de la fibre optique et du spot élémentaire conséquent ainsi que la juxtaposition finale des différents impacts contigus en optimalisant l'ordre de distribution des tirs laser pour qu'au moins lors de deux tirs laser consécutifs, les spots élémentaires conséquents ne soient pas contigus afin d'éviter les effets d'accumulation thermique de l'impact précédent.According to the present invention, the systematized treatment instrument, comprising means for treating an area of a body, in particular usable in dermatology for the treatment of angiomas, the said instrument being in particular connected to a source of laser radiation and having a frame in which is also arranged an optical fiber making it possible to transmit the laser energy and to form an elementary spot at the level of the impact with the zone under investigation, is characterized by the fact that it comprises: on the one hand means for relative positioning of the optical fiber with respect to the area of the body under investigation, and on the other hand means for sequential scanning of said area which make it possible to control the position of the optical fiber and the consequent elementary spot as well as the final juxtaposition of the different contiguous impacts by optimizing the order of distribution of the laser shots so that at least during two consecutive laser shots, the consequent elementary spots are not contiguous to avoid the thermal accumulation effects of the previous impact.
La présente invention sera mieux comprise à la lecture de la description suivante accompagnée des dessins en annexe qui en font partie intégrante. La figure 1 représente une vue schématique en perspective d'un mode de réalisation de l'instrument de traitement systématisé de la présente invention qui permet d'en illustrer le principe de fonctionnement.The present invention will be better understood on reading the following description accompanied by the accompanying drawings which form an integral part thereof. FIG. 1 represents a schematic perspective view of an embodiment of the systemized processing instrument of the present invention which makes it possible to illustrate the principle of operation thereof.
La figure 2 montre une disposition préférentielle des zones unitaires de traitement formées par la juxtaposition de spots élémentaires contigus selon la présente invention.FIG. 2 shows a preferential arrangement of the unitary treatment zones formed by the juxtaposition of contiguous elementary spots according to the present invention.
La figure 3 est une vue en coupe d'un mode de réalisation plus détaillé d'un instrument de traitement systématisé réalisé selon 1' invention. La figure 4 montre une vue schématique partielle de dessous de l'instrument représenté à la figure 3 qui montre la modularité de la zone unitaire traitée.Figure 3 is a sectional view of a more detailed embodiment of a systematized treatment instrument produced according to the invention. Figure 4 shows a partial schematic view from below of the instrument shown in Figure 3 which shows the modularity of the unit area treated.
La figure 5 illustre un mode de balayage de la fibre optique de l'instrument de traitement de la présente invention autorisant une séquence de spots élémentaires consécutifs et contigus .FIG. 5 illustrates a scanning mode of the optical fiber of the processing instrument of the present invention allowing a sequence of consecutive and contiguous elementary spots.
La figure 6 représente un autre mode de balayage préférentiel qui illustre une séquence de tirs laser consécutifs formant des spots élémentaires conséquents non contigus, toutefois la juxtaposition finale présentant alors des impacts contigus.FIG. 6 represents another preferred scanning mode which illustrates a sequence of consecutive laser shots forming consequent elementary spots not contiguous, however the final juxtaposition then having contiguous impacts.
La figure 7 montre une vue de détail de l'instrument de traitement de la présente invention qui illustre ses moyens de dialogue et d'affichage.FIG. 7 shows a detailed view of the processing instrument of the present invention which illustrates its dialogue and display means.
La figure 8 montre une implantation possible de l'instrument de traitement systématisé de la présente invention sur une potence de façon à faciliter son utilisation par le praticien.FIG. 8 shows a possible implantation of the systemized treatment instrument of the present invention on a bracket so as to facilitate its use by the practitioner.
La présente invention vise un instrument de traitement systématisé dont l'application majeure sera médicale notamment en -ε- dermatologie pour le traitement des angiomes plans.The present invention relates to a systemized treatment instrument whose major application will be medical, in particular in -ε- dermatology for the treatment of plane angiomas.
Toutefois, il est â remarquer qu'il pourrait être utilisé pour toute autre application de traitement d'une zone d'un corps nécessitant ces effets. De plus, le terme "corps" est à prendre dans son sens large c'est-à-dire qu'il peut être formé par des tissus vivants ou par toute autre matière inerte. De plus, par "zone sous investigation" repérée 2 sur les figures, il faut entendre la surface unitaire qui est soumise aux effets de l'instrument de traitement systématisé de l'invention lors d'un positionnement.However, it should be noted that it could be used for any other application for treating an area of the body requiring these effects. In addition, the term "body" is to be taken in its broad sense, that is to say that it can be formed by living tissue or by any other inert material. In addition, by "area under investigation" identified 2 in the figures, it is meant the unit surface which is subjected to the effects of the systemized treatment instrument of the invention during positioning.
L'instrument de traitement systématisé de la présente invention comprend des moyens de traitement d'une zone d'un corps qui utiliseront les effets thermiques d'une source laser afin d'obtenir, dans le cas des angiomes plans, l'obturation des vaisseaux sanguins du derme par photocoagulation.The systematized treatment instrument of the present invention comprises means for treating an area of a body which will use the thermal effects of a laser source in order to obtain, in the case of planar angiomas, the obturation of the vessels. dermal blood cells by photocoagulation.
Pour mettre en oeuvre ce procédé de traitement d'une manière fiable et pour optimaliser le résultat obtenu, il est impératif de maitriser parfaitement certains paramètres fondamentaux qui sont d'une part des paramètres thermiques et d'autre part des paramètres géométriques.To implement this treatment process in a reliable manner and to optimize the result obtained, it is imperative to perfectly master certain fundamental parameters which are on the one hand thermal parameters and on the other hand geometric parameters.
En effet, rappelons que pour maitriser le procédé de traitement, il est nécessaire de contrôler la puissance d'irradiation, le temps d'exposition, et de tenir compte de l'effet de diffusion thermique pour éviter toute surcharge de température au niveau des impacts. Dans le cas des angiomes plans, ces différents paramètres thermiques doivent aboutir à une focalisation précise au niveau du vaisseau à coaguler et la température de chauffage doit être comprise entre 60 et 80 *C pour éviter tout risque cicatriciel préjudiciable. En ce qui concerne les paramètres géométriques, il s'agit en fait de contrôler l'uniformité des spots émis, et leur juxtaposition précise afin que la zone unitaire sous investigation soit complètement couverte par une multitude d'impacts contigus de tirs laser consécutifs. Par ailleurs, il est nécessaire de définir la dimension de cette zone sous investigation selon le cas à traiter pour d'une part tenir compte de la géométrie de la zone sous investigation et d'autre part éviter un inconfort au patient pendant le traitement. Dans le cas de l'angiome plan, qui généralement occupe une surface importante de l'ordre de plusieurs centimètres carrés, la taille maximum de la zone élémentaire 2 à traiter sera donc volontairement limitée pour ces raisons. En effet, un angiome peut avoir dans les trois dimensions une cartographie très tourmentée et variée, comme par exemple dans le cas d'une joue et aile du nez. On limitera donc la taille de la zone unitaire 2 afin que l'on puisse considérer la surface traitée plane pour préserver une distance de tirs constante. Ceci permettra également de réduire le temps d'immobilisation du patient à des valeurs raisonnables inférieures à la minute.Indeed, remember that to master the treatment process, it is necessary to control the power of irradiation, the exposure time, and to take into account the effect of thermal diffusion to avoid any temperature overload at the level of impacts . In the case of port wine stains, these thermal parameters must achieve precise focusing at the vessel to coagulate and the heating temperature must be between 60 and 80 ° C to avoid damaging scar. With regard to the geometric parameters, it is in fact a question of controlling the uniformity of the spots emitted, and their precise juxtaposition so that the unit area under investigation is completely covered by a multitude of contiguous impacts of consecutive laser shots. Furthermore, it is necessary to define the dimension of this area under investigation according to the case to be treated in order to take into account on the one hand the geometry of the area under investigation and on the other hand to avoid discomfort to the patient during the treatment. In the case of plane angioma, which generally occupies a large area of the order of several square centimeters, the maximum size of the elementary area 2 to be treated will therefore be voluntarily limited for these reasons. Indeed, an angioma can have in the three dimensions a very tormented and varied cartography, as for example in the case of a cheek and wing of the nose. We will therefore limit the size of the unit area 2 so that we can consider the flat treated surface to preserve a constant shooting distance. This will also reduce the patient's downtime to reasonable values less than one minute.
Afin de couvrir la totalité de la lésion, le praticien au lieu de juxtaposer les spots élémentaires manuellement selon la méthode traditionnelle, n'aura plus qu'à juxtaposer manuellement ces surfaces unitaires 2 comme le montre notamment la figure 2. Ceci permettra de réduire le nombre de positionnements de façon très importante et de diminuer considérablement le temps du traitement.In order to cover the entire lesion, the practitioner instead of juxtaposing the elementary spots manually according to the traditional method, will only have to manually juxtapose these unit areas 2 as shown in particular in Figure 2. This will reduce the number of positions very important and considerably reduce the treatment time.
Selon la présente invention, l'instrument de traitement systématisé 1 permet donc de répondre aux objectifs précités et d'automatiser le traitement de façon fiable et contrôlée à l'intérieur d'une surface unitaire 2.According to the present invention, the systematized treatment instrument 1 therefore makes it possible to meet the abovementioned objectives and to automate the treatment in a reliable and controlled manner inside a unitary surface 2.
Afin de faciliter la compréhension, la réalisation de l'instrument de traitement systématisé 1 de la présente invention va être faite à la vue des figures 1 et 3 qui illustrent respectivement le principe et une réalisation préférentielle détaillée de la présente invention.In order to facilitate understanding, the production of the systemized processing instrument 1 of the present invention will be made in view of FIGS. 1 and 3 which respectively illustrate the principle and a detailed preferred embodiment of the present invention.
L'instrument de traitement systématisé 1 est constitué autour d'un bâti 3 formé d'une platine support d'appareillage 51 et d'une potence 20 et servant de support aux différents constituants. Plus précisément, dans ce bâti est disposée en outre une fibre optique 5 permettant de transmettre l'énergie laser et de former finalement un spot élémentaire 6 au niveau de l'impact avec la zone sous investigation 2. Pour ce l'instrument est notamment connecté à une source de rayonnements laser, non représentée, connexion repérée par •, sur les figures.The systematized treatment instrument 1 is formed around a frame 3 formed by an apparatus support plate 51 and a bracket 20 and serving as support for the various constituents. More precisely, in this frame is also arranged an optical fiber 5 making it possible to transmit the laser energy and finally to form an elementary spot 6 at the level of the impact with the area under investigation 2. For this instrument the instrument is notably connected to a source of laser radiation, not shown, connection marked with •, in the figures.
Jusqu'à présent, une telle réalisation est connue de l'Homme de l'Art et on utilisera une fibre optique dont le diamètre permettra l'obtention finale d'un spot élémentaire 6 d'un diamètre compris entre 0,5 et 2 mm.Until now, such an embodiment is known to those skilled in the art and an optical fiber will be used whose diameter will allow the final production of an elementary spot 6 with a diameter between 0.5 and 2 mm.
La fibre optique 5 sera avantageusement au moins immobilisée en un point fixe 7 du bâti 3 qui comprendra un système de centrage et d'immobilisation 8 du type presse-étoupe. Par ailleurs, l'extrémité 9 de la fibre optique 5, montée sur le bâti 3, qui peut constituer une source de rayonnement laser mobile de faible inertie est placée en regard d'une optique de focalisation 10, l'ensemble fibre optique 5 et optique de focalisation 10 définissant alors un axe principal optique 11. En ce qui concerne la réalisation proprement dite de l'optique de focalisation 10, elle formera un objectif constitué de deux lentilles plans convexes 12, 13 formant un doublet symétrique selon les techniques classiques centré sur l'axe principal *• . . Le doublet est immobilisé axialement et solidaire du bâti 3 par la monture 14.The optical fiber 5 will advantageously be at least immobilized at a fixed point 7 of the frame 3 which will include a centering and immobilization system 8 of the cable gland type. Furthermore, the end 9 of the optical fiber 5, mounted on the frame 3, which can constitute a source of mobile laser radiation of low inertia is placed opposite a focusing optic 10, the optical fiber assembly 5 and focusing optics 10 then defining an optical main axis 11. As regards the actual production of the focusing optics 10, it will form an objective consisting of two convex planar lenses 12, 13 forming a symmetrical doublet according to conventional techniques centered on the main axis * •. . The doublet is immobilized axially and secured to the frame 3 by the mount 14.
Il est à remarquer que de par cette disposition on reforme l'image inversée de l'extrémité 9 de la fibre optique. 0e plus, son ouverture sera telle que le faisceau issu de la fibre soit intercepté pour couvrir toute la surface unitaire 2 à traiter. Par ailleurs, selon la présente invention, l'instrument de traitement 1 comporte essentiellement d'une part des moyens de positionnement 15 relatif dé la fibre optique 9 vis-à-vis de la zone du corps sous investigation 2, et d'autre part des moyens de balayage séquentiel 16 de la dite zone sous investigation qui permettent de contrôler la position de l'extrémité de la figure optique 9 et du spot élémentaire 6 conséquent ainsi que la juxtaposition finale des différents impacts contigus 17 formés en optimalisant l'ordre de distribution des tirs laser pour qu'au moins lors de deux tirs laser consécutifs les spots élémentaires 6 conséquents ne soient pas contigus afin d'éviter les effets d'accumulation thermique de l'impact précédent.It should be noted that by this arrangement, the inverted image of the end 9 of the optical fiber is reformed. 0e more, its opening will be such that the beam from the fiber is intercepted to cover the entire unit surface 2 to be treated. Furthermore, according to the present invention, the treatment instrument 1 essentially comprises, on the one hand, means of positioning 15 relative to the optical fiber 9 with respect to the area of the body under investigation 2, and on the other hand sequential scanning means 16 of said area under investigation which make it possible to control the position of the end of the optical figure 9 and of the consequent elementary spot 6 as well as the final juxtaposition of the different contiguous impacts 17 formed by optimizing the order of distribution of the laser shots so that at least during two consecutive laser shots the elementary spots 6 consequent are not contiguous in order to avoid the effects of thermal accumulation of the previous impact.
Plus particulièrement, comme le montre la réalisation préférentielle des figures 1 et 3, les moyens de balayage séquentiel 16 sont constitués par un dispositif mécanique déplaçant séquentiellement l'extrémité 9 de la fibre optique 5 dans un plan 50 perpendiculaire à l'axe principal optique 11 afin d'engendrer le déplacement et le positionnement repéré du spot élémentaire 6 sur toute la surface unitaire sous investigation 2 ceci notamment par 1' intermédiaire de l'optique de focalisation 10 précité. Ainsi, on pourra effectuer une suite de tirs laser séquentiellement afin de couvrir toute la surface unitaire sous investigation 2.More particularly, as shown in the preferred embodiment of FIGS. 1 and 3, the sequential scanning means 16 are constituted by a mechanical device sequentially moving the end 9 of the optical fiber 5 in a plane 50 perpendicular to the main optical axis 11 in order to generate the displacement and the identified positioning of the elementary spot 6 over the entire unit surface under investigation 2 this in particular by 1 through the aforementioned focusing optics 10. Thus, it will be possible to carry out a series of laser shots sequentially in order to cover the entire unit surface under investigation 2.
Le dispositif mécanique engendrant ce déplacement biaxial est formé notamment par deux systèmes bielle manivelle 18 et 19 tous deux solidaires du bâti .3 et montés sur la platine 51; on forme donc un système fixe par rapport au bâti 3, le point fixe 7 de la fibre optique et les bielles manivelles 18 et 19 étant réunis par l'intermédiaire d'une potence 20. Les deux systèmes bielle-manivelle 18 et 19 sont chacun entrainés par un organe moteur respectivement 21 et 22 coopérant entre eux au niveau des extrémités de chaque bielle, respectivement repérées 23 et 24, pour constituer une articulation commune 25 à laquelle est solidarisée l'extrémité 9 de la fibre optique 5. Afin de déplacer la fibre optique 5 en abscisse et en ordonnée repérées dans le plan 50 en formant une zone sensiblement semblable à la zone sous-investigation 2, les organes moteur 21, 22 de chaque système bielle-manivelle 18, 19 sont commandés indépendamment et leur rotation est contrôlée pour engendrer le balayage séquentiel par l'extrémité mobile 9 de la fibre optique de toute la surface correspondante à la surface unitaire de traitement 2.The mechanical device generating this biaxial movement is formed in particular by two crank rod systems 18 and 19, both integral with the frame .3 and mounted on the plate 51; a fixed system is therefore formed relative to the frame 3, the fixed point 7 of the optical fiber and the crank rods 18 and 19 being joined by means of a bracket 20. The two crank-rod systems 18 and 19 are each driven by a motor member 21 and 22 respectively cooperating with each other at the ends of each connecting rod, respectively marked 23 and 24, to form a common articulation 25 to which the end 9 of the optical fiber 5 is secured. In order to move the optical fiber 5 on the abscissa and on the ordinate identified in the plane 50 by forming a zone substantially similar to the zone under investigation 2, the drive members 21, 22 of each rod-crank system 18, 19 are controlled independently and their rotation is controlled to generate the sequential scanning by the mobile end 9 of the optical fiber of the entire surface corresponding to the unitary processing surface 2.
Ainsi, si des angles de rotation sont imposés aux manivelles respectivement repérées 26 et 27. on engendre un mouvement et un positionnement relatif de l'articulation 25 par rapport à l'axe principal optique 11. De plus, si leur vitesse angulaire relative et absolue est imposée, la trajectoire du mouvement et sa vitesse sont également définies.Thus, if angles of rotation are imposed on the cranks respectively marked 26 and 27. this generates a movement and a relative positioning of the articulation 25 relative to the main optical axis 11. In addition, if their relative and absolute angular speed is imposed, the trajectory of the movement and its speed are also defined.
Ainsi la figure du chemin des déplacements a la forme d'un pseudo-losange 28 dont les côtés sont des portions de cercle. Il est à remarquer que dans cette forme, on pourra notamment circonscrire un hexagone 29 formé par l'ensemble des positions réellement exploitées.Thus the figure of the path of displacements has the form of a pseudo-diamond 28 whose sides are portions of a circle. It should be noted that in this form, it is possible in particular to circumscribe a hexagon 29 formed by all of the positions actually used.
La réalisation de ce système sera tel que les impératifs optiques soient respectés et notamment on s'assurera qu'une portion de l'extrémité 9 de la fibre optique 5 soit sensiblement parallèle à l'axe optique 11 pour cela on dédoublera avantageusement l'articulation 25 comme le montrent les figures 1 et 3. De plus, on s'assurera également que la flexion imposée à la fibre optique ne soit pas préjudiciable pour éviter une fatigue mécanique ainsi que les pertes optiques.The implementation of this system will be such that the optical requirements are met and in particular it will be ensured that a portion of the end 9 of the optical fiber 5 is substantially parallel to the optical axis 11 for this, the articulation will advantageously be split. 25 as shown in FIGS. 1 and 3. In addition, it will also be ensured that the bending imposed on the optical fiber does not is not harmful to avoid mechanical fatigue as well as optical losses.
Ainsi, les moyens de balayage séquentiel 16 forment une structure isostatique dans laquelle la fibre optique joue le rôle d'un équipage mobile vis-à-vis du bâti 3.Thus, the sequential scanning means 16 form an isostatic structure in which the optical fiber plays the role of a moving assembly with respect to the frame 3.
En ce qui concerne l'entrainement proprement dit des systèmes bielle-manivelle 18, 19, les organes moteur 21 et 22 se présentent sous la forme de moteur "pas à pas" alimentés par des niveaux analogiques de courant prédéterminés permettant de diviser Les "pas standards" des moteurs en plusieurs "micro-pas" afin d'augmenter la précision de positionnement.As regards the actual drive of the rod-crank systems 18, 19, the drive members 21 and 22 are in the form of a "stepper" motor supplied by predetermined analog current levels making it possible to divide the "steps standard "motors in several" micro-steps "to increase positioning accuracy.
A titre d'exemple non limitatif, on divise linéairement les pas principaux en 32 micro-pas entraînant une résolution de positionnement de 0,02 mm référé aux spots élémentaires de 1 mm ce qui autorisera une résolution largement suffisante dans l'application du traitement considéré.By way of nonlimiting example, the main steps are divided linearly into 32 micro-steps resulting in a positioning resolution of 0.02 mm referred to the elementary spots of 1 mm which will allow a resolution that is largely sufficient in the application of the treatment considered .
Par ailleurs, la rotation angulaire de chaque moteur 21, 22 étant relative, des séquences d'initialisation absolues sont nécessaires pour contrôler leur positionnement. A cet égard, chaque système bielle-manivelle 18, 19 est asservi à un capteur de position, respectivement repéré 30, 31 autorisant une initialisation périodique du positionnement des organes moteur 21, 22.Furthermore, the angular rotation of each motor 21, 22 being relative, absolute initialization sequences are necessary to control their positioning. In this regard, each rod-crank system 18, 19 is slaved to a position sensor, respectively marked 30, 31 authorizing a periodic initialization of the positioning of the drive members 21, 22.
En ce qui concerne la réalisation pratique de ce dispositif d'initialisation, les capteurs utilisés seront des capteurs de position fixes vis-à-vis du bâti 3 et positionnés en regard d'un index disposé sur les manivelles 26, 27. De plus, il est à remarquer que cet ensemble de capteurs ne nécessite aucune précision car il ne repère que des positions correspondantes à chaque séquence répétée soit par exemple tous les quatre pas car on retrouve dans ce cas un état électrique identique pour le moteur.As regards the practical embodiment of this initialization device, the sensors used will be fixed position sensors with respect to the frame 3 and positioned opposite an index disposed on the cranks 26, 27. In addition, it should be noted that this set of sensors does not require any precision because it only locates positions corresponding to each repeated sequence, for example every four steps because in this case we find an identical electrical state for the motor.
Il est à noter que de ce fait on évite l'utilisation de capteurs d'avertissement continu tels que des capteurs potientiometriques ou des codeurs optiques plus difficiles à mettre en oeuvre et plus coûteux. Par contre, le calage angulaire mécanique des moteurs 21,It should be noted that this avoids the use of continuous warning sensors such as potientiometric sensors or optical encoders which are more difficult to implement and more expensive. On the other hand, the mechanical angular setting of the motors 21,
22 doit être parfait. On effectuera ce dernier par bridage 32 des moteurs sur la platine 20 pour les immobiliser vis-à-vis du bâti 3, ceci selon des techniques connues. En ce qui concerne les moyens de positionnement 15 relatif de la fibre optique 5 et de son optique de focalisation 10 vis-à-vis de la zone du corps sous investigation 2, ils seront constitués par un ensemble d'entretoises 32. fixé sous le bâti 3 et centré sur 5 l'axe principal optique 11. Ainsi, on prendra appui sur la zone du corps 2 et on pourra fixer la distance de tirs et par conséquent la taille et l'uniformité prévues des spots élémentaires 2.22 must be perfect. This will be done by clamping 32 of the motors on the plate 20 to immobilize them vis-à-vis the frame 3, this according to known techniques. As regards the relative positioning means 15 of the optical fiber 5 and its focusing optics 10 with respect to the area of the body under investigation 2, they will be constituted by a set of spacers 32. fixed under the frame 3 and centered on 5 the main optical axis 11. Thus, we will rest on the area of the body 2 and we will be able to set the shooting distance and consequently the size and uniformity provided for the elementary spots 2.
De plus, cet ensemble d'entretoises 33 présentera des moyens de réglage 34 pour adapter la distance de tirs à la valeur 11T souhaitée. Une telle réalisation mécanique est à la portée de l'Homme de l'Art.In addition, this set of spacers 33 will have adjustment means 34 to adapt the shooting distance to the desired value 11T. Such a mechanical realization is within the reach of the skilled person.
Par ailleurs, pour faciliter le positionnement par le praticien des différentes surfaces unitaires correspondantes aux zones sous investigation 2. comme le montre la figure 2, on pourra 15 prévoir un support indépendant adhésif, non représenté, préalablement appliqué sur l'épiderme du patient, ce support comportant des repères de positionnement visibles adaptés à la form'e géométrique de la surface unitaire 2. Alors, l'ensemble d'entretoises 33 présentera avantageusement une fenêtre découpée, au niveau du derme, qui 20 facilitera ce positionnement vis-à-vis du repérage adhésif.Furthermore, to facilitate the positioning by the practitioner of the different unit surfaces corresponding to the areas under investigation 2. as shown in FIG. 2, an independent adhesive support may be provided, not shown, previously applied to the epidermis of the patient, this support comprising visible positioning marks adapted to the geometric shape of the unit surface 2. Then, the set of spacers 33 will advantageously have a cut window at the dermis, which will facilitate this positioning with respect to adhesive marking.
Par ailleurs, selon la présente invention, on contrôle la puissance d'irradiation de la source laser et à cet égard l'instrument de traitement 1 présente des moyens de mesure de la puissance du rayonnement laser émis. 2.5 Ces moyens de mesure sont basés sur le principe de la sphère intégratrice qui est une méthode fidèle de mesure indirecte de puissance totale rayonnée.Furthermore, according to the present invention, the irradiation power of the laser source is controlled and in this regard the processing instrument 1 has means for measuring the power of the emitted laser radiation. 2.5 These means of measurement are based on the principle of the integrating sphere which is a faithful method of indirect measurement of total radiated power.
En ce qui concerne leur réalisation pratique, ils sont constitués par une pseudo-sphère intégratrice, formée par la montureRegarding their practical realization, they are constituted by an integrating pseudo-sphere, formed by the frame
30 14 support de l'optique de focalisation 10, obturée au niveau de la source par un couvercle mobile 36 et en amont du doublet 12, 13 par l'obturateur 38, dont la description sera donnée ultérieurement.30 14 support for the focusing optic 10, closed at the source by a movable cover 36 and upstream of the doublet 12, 13 by the shutter 38, the description of which will be given later.
La monture 14 sera réalisée telle que l'ensemble des surfaces de la cavité soit réfléchissant et diffusant du rayonnement 35 spécifique du laser. Une partie du rayonnement total diffusé est prélevée et mesurée par un capteur photoélectrique 37 qui sera avantageusement muni d'un filtre adapté au laser. De plus, la fibre optique 5 sera positionnée pendant la mesure coaxialement à l'axe principal optique 11 et la mesure proprement dite sera réalisée et traitée par des techniques à la portée de l'Homme de l'Art.The mount 14 will be made such that all of the surfaces of the cavity are reflecting and diffusing specific radiation from the laser. Part of the total scattered radiation is sampled and measured by a photoelectric sensor 37 which will advantageously be fitted with a filter adapted to the laser. In addition, the optical fiber 5 will be positioned during the measurement coaxial to the axis. main optic 11 and the actual measurement will be performed and processed by techniques within the reach of ordinary skill in the art.
Enfin, en ce qui concerne la partie optique proprement dite de l'instrument à main de la présente invention, ce dernier comprend des moyens d'obturation 38 commandés et synchronisés avec les dits moyens de balayage 16 pour contrôler le temps d'exposition de chaque tir indépendamment des conditions de fonctionnement de la source laser.Finally, with regard to the actual optical part of the hand instrument of the present invention, the latter comprises shutter means 38 controlled and synchronized with said scanning means 16 for controlling the exposure time of each regardless of the operating conditions of the laser source.
Plus précisément, l'obturateur 38 est constitué d'une palette 3"9f, mobile angulairement sur un axe 40 parallèle à l'axe principal optique 11. Elle est entrainée par un système mécanique à bras de levier par un électro-aimant 41 par exemple. Une telle réalisation est notamment connue de l'Homme de l'Art.More specifically, the shutter 38 consists of a 3 " 9f pallet, angularly movable on an axis 40 parallel to the main optical axis 11. It is driven by a mechanical system with a lever arm by an electromagnet 41 by example. Such an embodiment is notably known to a person skilled in the art.
Toutefois, le plan d'obturation a été choisi dans une zone afocale privilégiée constituée par le pseudo-foyer des faisceaux générés par la nature diaphragmée de la source objet. De plus, la palette est constituée en matière réfléchissante diffusante telle qu'en alliage d'aluminium.However, the obturation plan was chosen in a privileged afocal zone constituted by the pseudo-focus of the beams generated by the diaphragm nature of the object source. In addition, the pallet is made of diffusing reflective material such as aluminum alloy.
Par ailleurs, pour gérer le fonctionnement automatique des différents moyens qui viennent d'être décrits, l'instrument 1 de la présente invention comporte une unité de commande automatique du dit instrument organisée autour d'une unité centrale électronique, d'une base de temps et de circuits annexes qui autorisent en outre le contrôle des moyens de balayage, la mesure de la puissance de l'irradiation, la commande des moyens d'obturation synchronisée, le dialogue avec l'opérateur.Furthermore, to manage the automatic operation of the various means which have just been described, the instrument 1 of the present invention comprises an automatic control unit of the said instrument organized around a central electronic unit, of a time base and additional circuits which also allow the control of the scanning means, the measurement of the power of the irradiation, the control of the synchronized shutter means, the dialogue with the operator.
Ces différents éléments électroniques seront constitués par des composants électroniques tels que micro-processeur, mémoire vive, mémoire morte et autres circuits intégrés dont la mise en oeuvre est à la portée de l'Homme de l'Art considéré.These various electronic elements will consist of electronic components such as microprocessor, random access memory, read-only memory and other integrated circuits, the implementation of which is within the reach of the skilled person.
Toutefois en ce qui concerne le circuit de contrôle des moyens de balayage, il comporte au moins une mémoire dans laquelle sont introduites des données afin d'autoriser une séquence de tir laser pour couvrir par leurs impacts 17 une figure géométrique 29 par juxtaposition de spots élémentaires 6 contigus parfaitement reproductible dans le temps.However as regards the control circuit of the scanning means, it comprises at least one memory into which data are entered in order to authorize a laser firing sequence to cover by their impacts 17 a geometric figure 29 by juxtaposition of elementary spots 6 contiguous perfectly reproducible over time.
A cet égard, pour faciliter ultérieurement la répartition manuelle par le praticien des surfaces unitaires 2, la figure géométrique se présente avantageusement sous la forme d'un hexagone régulier, leur jointure mutuelle étant parfaite par six axes différents à 60 degrés. De plus, l'hexagone est la continuité géométrique du triangle de base constitué par trois spots 6 5 circulaires contigus entre eux.In this regard, to later facilitate manual distribution by the practitioner of the unit areas 2, the figure Geometrically advantageously takes the form of a regular hexagon, their mutual joining being perfect by six different axes at 60 degrees. In addition, the hexagon is the geometric continuity of the basic triangle formed by three circular spots 6 5 contiguous to each other.
On a remarqué de bons résultats en formant un hexagone dont la diagonale est comprise entre 3 et 20 mm, formé par juxtaposition de spots élémentaires de diamètre compris entre 0,5 et 2 mm.We have noticed good results in forming a hexagon whose diagonal is between 3 and 20 mm, formed by juxtaposition of elementary spots of diameter between 0.5 and 2 mm.
De plus, l'électronique de commande est réalisée telle queIn addition, the control electronics are designed such that
1î0- par l'intermédiaire du circuit de dialogue et du circuit de contrôle des moyens de balayage, la surface de la figure géométrique est modulable comme le montre particulièrement la figure 4. A cet égard, on autorisera par exemple une sélection de six champs se répartissent et autorisant notamment des hexagones de diagonales comprises entre1î0- through the dialogue circuit and the control circuit of the scanning means, the surface of the geometrical figure is modular as shown in particular in Figure 4. In this regard, we will allow for example a selection of six fields distribute and authorize in particular hexagons of diagonals between
15 3 et 20 mm, chaque champ étant centré sur l'axe optique principal 11.15 3 and 20 mm, each field being centered on the main optical axis 11.
Un des aspects original de la présente invention concerne l'ordre de distribution automatique des tirs laser afin de couvrir à la fin d'une séquence de tir complètement la surface unitaire de la zone sous investigation 2 par une juxtaposition contigue desOne of the original aspects of the present invention relates to the order of automatic distribution of the laser shots in order to completely cover at the end of a shooting sequence the unit surface of the area under investigation 2 by a contiguous juxtaposition of the
20 différents spots élémentaires 6 émis lors de la séquence.20 different elementary spots 6 emitted during the sequence.
Toutefois, au cours de cinéthermographies d'un tir laser isolé élevant la température au niveau de l'impact de 60 à 80 *C, on a relevé un temps de relaxation thermique de l'ordre de 1,5 secondes après ce tir avec une diffusion de température confinée sur unHowever, during cinéthermographies an isolated laser shot raising the temperature at the impact of 60 to 80 ° C, there was a thermal relaxation time of the order of 1.5 seconds after the shot with a temperature diffusion confined to a
2.5.' diamètre de 3 à 4 mm au niveau du derme.2.5. '' 3 to 4 mm diameter at the dermis.
Ainsi des tirs juxtaposés répétitifs dans cette zone de diffusion et avant relaxation induisent un phénomène d'accumulation et par conséquent une surcharge en température.Thus repetitive juxtaposed shots in this diffusion zone and before relaxation induce a phenomenon of accumulation and consequently an overload in temperature.
Ce phénomène est négligeable dans le cas d'une pratique 30 manuelle telle que l'effectue actuellement le praticien car les temps de positionnement sont largement supérieurs aux temps de relaxation thermique. Par contre, lors d'un balayage automatique très rapide, des tirs juxtaposés répétitifs nécessitent une temporisation entre chaque tir pour qu'il y ait relaxation. 35 Toutefois, ce phénomène d'accumulation thermique augmente le temps nécessaire pour traiter une zone définie, c'est pourquoi la présente invention propose un mode de balayage optimisé afin de couvrir la surface unitaire sous investigation dans un temps de cycle infê-c eur à la minute et même voisin de 40 secondes.This phenomenon is negligible in the case of manual practice as currently practiced by the practitioner because the positioning times are much greater than the thermal relaxation times. On the other hand, during a very rapid automatic scanning, repetitive juxtaposed shots require a time delay between each shot so that there is relaxation. However, this phenomenon of thermal accumulation increases the time necessary to treat a defined area, this is why the present invention proposes an optimized scanning mode in order to cover the unit surface under investigation in a cycle time. inferior to the minute and even close to 40 seconds.
Ce mode de balayage autorisé par les moyens de balayage séquentiel de la présente invention permet au moins de réaliser deux tirs laser consécutifs sans pour autant que les spots élémentaires 6 conséquents ne soient contigus ceci afin d'éviter les effets d'accumulation thermique dus à la diffusion de la température et à la périphérie d'un impact. Néanmoins à l'issue de cette séquence tous les impacts 17 seront juxtaposés et parfaitement contigus les uns les autre-.. • A ce sujet, la figure 6 montre un ordre de balayage séquentiel par lequel, les spots élémentaires 6 ayant un diamètre sensiblement voisin d'un millimètre, les spots successifs sont alors toujours éloignés d'au moins deux millimètres. Ceci permet de mettre en oeuvre des temps de répétition de tirs d'une valeur moyenne de 140 millisecondes et par suite de réduire considérablement le temps du traitement d'une surface élémentaire 2.This scanning mode authorized by the sequential scanning means of the present invention allows at least two consecutive laser shots to be carried out without the consequent elementary spots 6 being contiguous this in order to avoid the effects of thermal accumulation due to the diffusion of the temperature and the periphery of an impact. However, at the end of this sequence, all of the impacts 17 will be juxtaposed and perfectly contiguous with each other. • On this subject, FIG. 6 shows a sequential scanning order by which, the elementary spots 6 having a substantially similar diameter by one millimeter, the successive spots are then always at least two millimeters apart. This makes it possible to use firing repetition times with an average value of 140 milliseconds and consequently considerably reduce the time for processing an elementary surface 2.
Dans ce cas, l'unité de commande automatique du système et son circuit de contrôle des moyens de balayage sont programmés par un logiciel qui permet de repérer en abscisse et en ordonnée les différentes positions des spots élémentaires 6 et de déplacer la fibre optique à cet égard par des rotations contrôlées des organes d'entrainement 21 et 22 du système de balayage 16. Ce mode de balayage illustré est tout à fait arbitraire et d'autres modes de balayage pourraient être envisagés par programmations différentes. Toutefois, il est à remarquer que l'unité de commande comporte des moyens pour annihiler le balayage séquentiel de tirs laser formant des spots disjoints pour autoriser soit un balayage automatique de spots contigus consécutifs comme le montre la figure 5 soit un balayage manuel traditionnel. En outre, pour introduire les différentes données et déclencher le mode d'utilisation souhaité, le praticien dispose d'un tableau d'affichage et de commande 42, tel que représenté à la figure 7, qui sera avantageusement séparé de l'instrument de traitement 1 proprement dit afin d'éviter un encombrement trop important. Il en est de même d'ailleurs pour la localisation de l'unité de commande précité.In this case, the automatic control unit of the system and its control circuit of the scanning means are programmed by software which makes it possible to locate on the abscissa and on the ordinate the different positions of the elementary spots 6 and to move the optical fiber to this regard by controlled rotations of the drive members 21 and 22 of the scanning system 16. This illustrated scanning mode is entirely arbitrary and other scanning modes could be envisaged by different programming. However, it should be noted that the control unit includes means for canceling the sequential scanning of laser shots forming disjoint spots to authorize either an automatic scanning of consecutive contiguous spots as shown in FIG. 5 or a traditional manual scanning. In addition, to introduce the various data and trigger the desired mode of use, the practitioner has a display and control panel 42, as shown in FIG. 7, which will advantageously be separated from the treatment instrument. 1 itself in order to avoid too much space. It is the same also for the location of the aforementioned control unit.
Ce tableau de commande 42 permettra par exemple de disposer de voyants tests du fonctionnement interne du système en 43, de contrôler la mesure de puissance par un affichage en 44, de contrôler le temps d'exposition et d'introduire ces données en 45, de sélectionner le type de balayage et de choisir l'ampleur du champ de traitement en 46. Ces différents éléments sont réalisés selon des techniques courantes de l'électronique.This control panel 42 will make it possible, for example, to have test indicators of the internal functioning of the system at 43, control the power measurement by a display at 44, control the exposure time and enter this data at 45, select the type of scan and choose the extent of the treatment field at 46. These various elements are made using standard electronics techniques.
Enfin, pour faciliter l'intervention du praticien lors du traitement, l'instrument de traitement 1 de la présente invention sera avantageusement supporté par la flèche 48 d'une potence 47, l'unité centrale électronique et le tableau de commande 42 étant disposés sur le mât de la potence 47 notamment en 49 sur la figure 8. Naturellement, d'autres mises en oeuvre de la présente invention, à la portée de l'Homme de l'Art, pourraient être envisagées sans pour autant sortir du cadre de celle-ci. Finally, to facilitate the intervention of the practitioner during treatment, the treatment instrument 1 of the present invention will advantageously be supported by the arrow 48 of a bracket 47, the electronic central unit and the control panel 42 being arranged on the mast of the gallows 47, in particular at 49 in FIG. 8. Naturally, other implementations of the present invention, within the reach of those skilled in the art, could be envisaged without going beyond the ambit of that -this.

Claims

-1S- REVENOICATIONS 1. Instrument de traitement systématisé (1), comprenant des moyens de traitement d'une zone d'un corps, notamment utilisable en dermatologie pour le traitement des angiomes plans, le dit instrument (1) étant notamment connecté en (4) à une source de rayonnement laser et présentant un bâti (3) dans lequel est disposée en outre une fibre optique (5) permettant de transmettre l'énergie laser et de former un spot élémentaire (6) au niveau de l'impact (17) avec la zone sous-investigation (2), caractérisé par le fait qu'il comporte : - des moyens de positionnement (15) relatifs de la fibre optique (5) vis-à-vis de la zone du corps sous investigation (2),-1S- REVENOICATIONS 1. Systematic treatment instrument (1), comprising means for treating an area of a body, in particular usable in dermatology for the treatment of plane angiomas, said instrument (1) being in particular connected by ( 4) to a source of laser radiation and having a frame (3) in which is also arranged an optical fiber (5) making it possible to transmit the laser energy and to form an elementary spot (6) at the level of the impact ( 17) with the area under investigation (2), characterized in that it comprises: - positioning means (15) relative to the optical fiber (5) with respect to the area of the body under investigation ( 2),
- des moyens de balayage séquentiel (16) de la dite zone (2), qui permettent de contrôler la position de la fibre optique (5) et du spot élémentaire (6) conséquent ainsi que la juxtaposition finale des impacts contigus (17) en optimalisant l'ordre de distribution des tirs laser pour qu'au moins, lors de deux tirs laser consécutifs, les spots élémentaires (6) conséquents ne soient pas contigus afin d'éviter les effets d'accumulation thermique de l'impact précédent. - sequential scanning means (16) of said zone (2), which make it possible to control the position of the optical fiber (5) and of the elementary spot (6) therefore as well as the final juxtaposition of the contiguous impacts (17) in optimizing the order of distribution of the laser shots so that at least, during two consecutive laser shots, the elementary spots (6) are not contiguous in order to avoid the effects of thermal accumulation from the previous impact.
2. Instrument de traitement selon la revendication 1, caractérisé par le fait qu'il comprend des moyens de mesure de la puissance du rayonnement laser émis pour contrôler la puissance d'irradiation.2. Treatment instrument according to claim 1, characterized in that it comprises means for measuring the power of the laser radiation emitted to control the irradiation power.
3. Instrument de traitement selon la revendication 1, caractérisé par le fait qu'il comprend des moyens d'obturation (38) commandés et synchronisés avec les dits moyens de balayage (16) pour contrôler le temps d'exposition de chaque tir indépendamment des conditions de fonctionnement de la source laser.3. Treatment instrument according to claim 1, characterized in that it comprises shutter means (38) controlled and synchronized with said scanning means (16) to control the exposure time of each shot independently of operating conditions of the laser source.
4. Instrument de traitement selon la revendication 1, la fibre optique (5) étant au moins immobilisée en un point fixe (7) du bâti (3) et son extrémité (9) étant en regard d'une optique de focalisation (10) définissant avec la fibre optique (5) un axe principal optique (11), caractérisé par le fait que les moyens de balayage séquentiel (16) sont constitués par un dispositif mécanique déplaçant séquentiellement l'extrémité (9) de la fibre optique (5) dans un plan (50) perpendiculaire à l'axe principal optique (11) afin d'engendrer le déplacement et le positionnement repéré du spot élémentaire (6).4. Treatment instrument according to claim 1, the optical fiber (5) being at least immobilized at a fixed point (7) of the frame (3) and its end (9) being opposite a focusing optic (10) defining with the optical fiber (5) an optical main axis (11), characterized in that the sequential scanning means (16) are constituted by a mechanical device sequentially moving the end (9) of the optical fiber (5) in a plane (50) perpendicular to the main optical axis (11) in order to generate the displacement and the identified positioning of the spot elementary (6).
5. Instrument de traitement selon la revendication 4, caractérisé par le fait que le dit dispositif mécanique est formé par deux systèmes bielle-manivelle (18, 19), solidaires du bâti (3) et entrainés chacun par un organe moteur (21, 22), coopérant entre eux au niveau des extrémités de chaque bielle (23, 24), pour constituer une articulation commune (25) à laquelle est solidarisée l'extrémité (9) de la fibre optique (5) afin de la déplacer dans un plan (50) en abscisse et en ordonnée repérées. " 5. Treatment instrument according to claim 4, characterized in that the said mechanical device is formed by two rod-crank systems (18, 19), integral with the frame (3) and each driven by a motor member (21, 22 ), cooperating with each other at the ends of each connecting rod (23, 24), to form a common articulation (25) to which the end (9) of the optical fiber (5) is secured in order to move it in a plane (50) on the abscissa and on the ordinate identified. "
6. Instrument de traitement selon la revendication 5, caractérisé par le fait que les organes moteur (21, 22) de chaque système bielle-manivelle (18, 19) sont commandés indépendamment et leur rotation est contrôlée pour engendrer le balayage séquentiel par l'extrémité mobile (9) de la fibre optique (5) d'une zone semblable (50) à la zone sous investigation (2).6. Treatment instrument according to claim 5, characterized in that the drive members (21, 22) of each rod-crank system (18, 19) are independently controlled and their rotation is controlled to generate sequential scanning by the movable end (9) of the optical fiber (5) of an area similar (50) to the area under investigation (2).
7. Instrument de traitement selon la revendication 5. caractérisé par le fait que les organes moteur (21, 22) des systèmes bielle-manivelle (18. 19) se présentent sous la forme de moteurs "pas à pas" alimentés par des niveaux analogiques de courant prédéterminés permettant de diviser les "pas standards" en plusieurs "micro-pas" pour augmenter la précision de positionnement.7. Treatment instrument according to claim 5. characterized in that the drive members (21, 22) of the rod-crank systems (18. 19) are in the form of "stepper" motors supplied by analog levels of predetermined current making it possible to divide the "standard steps" into several "micro-steps" to increase the positioning accuracy.
8. Instrument de traitement selon la revendication 5. caractérisé par le fait que chaque système bielle-manivelle (18, 19) est asservi à un capteur de position (30. 31) autorisant une initialisation périodique de positionnement des organes moteur (21, 22).8. Treatment instrument according to claim 5. characterized in that each rod-crank system (18, 19) is slaved to a position sensor (30. 31) authorizing a periodic initialization of positioning of the drive members (21, 22 ).
9. Instrument de traitement selon la revendication 1, présentant une optique de focalisation (10) immobilisée par une monture (14), portée par le bâti (3), et placée dans l'axe principal optique (11) sous l'extrémité (9) de la fibre optique (5), caractérisé par le fait que les moyens de positionnement (15) relatif de la fibre (5) et de son optique de focalisation (10) vis-à-vis de la zone du corps sous investigation (2) sont constitués par un ensemble d'entretoises (33). fixé sur le bâti (3) et centré sur l'axe principal optique (11). prenant appui sur la zone du corps (2), présentant des moyens de réglage (34) pour adapter la distance de tir et par conséquent la taille et l'uniformité des spots élémentaires (6). 9. Treatment instrument according to claim 1, having a focusing optic (10) immobilized by a mount (14), carried by the frame (3), and placed in the main optical axis (11) under the end ( 9) of the optical fiber (5), characterized in that the relative positioning means (15) of the fiber (5) and its focusing optics (10) with respect to the area of the body under investigation (2) are constituted by a set of spacers (33). fixed on the frame (3) and centered on the main optical axis (11). bearing on the area of the body (2), having adjustment means (34) to adapt the shooting distance and therefore the size and uniformity of the elementary spots (6).
10. Instrument de traitement selon la revendication 2, présentant une optique de focalisation (10) immobilisée par une monture (14), portée par le bâti (3), et placée dans l'axe principal optique (11) sous l'extrémité (9) de la fibre optique (5),10. Treatment instrument according to claim 2, having a focusing optic (10) immobilized by a mount (14), carried by the frame (3), and placed in the main optical axis (11) under the end ( 9) optical fiber (5),
5 caractérisé par le fait que les moyens de mesure du rayonnement laser sont constitués par une pseudo-sphère intégratrice formée par la monture (14) support de l'optique de focalisation (10), autorisant la mesure indirecte de la puissance totale rayonnée, réfléchissant et diffusant le rayonnement laser dont une partie est prélevée et t _ mesurée par un capteur photoélectrique (37) adapté au laser.5 characterized in that the means for measuring the laser radiation are constituted by an integrating pseudo-sphere formed by the mount (14) supporting the focusing optics (10), allowing the indirect measurement of the total radiated power, reflecting and diffusing the laser radiation, part of which is sampled and t _ measured by a photoelectric sensor (37) adapted to the laser.
11. Instrument de traitement selon la revendication 1, caractérisé par le fait qu'il comporte une unité de commande automatique (49) du dit instrument (1) organisée autour d'une unité centrale électronique, d'une base de temps et de circuits annexes qui11. Processing instrument according to claim 1, characterized in that it comprises an automatic control unit (49) of said instrument (1) organized around an electronic central unit, a time base and circuits annexes which
15 autorisent en outre le contrôle des moyens de balayage, la mesure de la puissance de l'irradiation, la commande des moyens d'obturation synchronisés, le dialogue avec l'opérateur.15 further authorize the control of the scanning means, the measurement of the power of the irradiation, the control of the synchronized shutter means, the dialogue with the operator.
12. Instrument de traitement selon la revendication 11, caractérisé par le fait que le circuit de contrôle des moyens de 0 balayage comporte au moins une mémoire dans laquelle sont introduites des données afin d'autoriser une séquence de tirs laser pour couvrir par leurs impacts (17) une figure géométrique (29), par juxtaposition de spots élémentaires contigus (6), parfaitement reproductible dans le temps. 512. Processing instrument according to claim 11, characterized in that the control circuit of the scanning means comprises at least one memory into which data are entered in order to authorize a sequence of laser shots to cover by their impacts ( 17) a geometric figure (29), by juxtaposition of contiguous elementary spots (6), perfectly reproducible over time. 5
13. Instrument de traitement -selon la revendication 12, caractérisé par le fait que la surface de la figure géométrique (29) est modulable par l'intermédiaire du circuit de dialogue et du circuit de contrôle des moyens de balayage.13. Processing instrument - according to claim 12, characterized in that the surface of the geometrical figure (29) is modular through the dialogue circuit and the control circuit of the scanning means.
14. Instrument de traitement selon la revendication 12, 0 caractérisé par le fait que la figure géométrique (29) se présente sous la forme d'un hexagone régulier dont la diagonale est comprise entre 3 et 20 mm formé par juxtaposition de spots élémentaires (6) de diamètre compris entre 0,5 et 2 mm.14. Treatment instrument according to claim 12, 0 characterized in that the geometric figure (29) is in the form of a regular hexagon whose diagonal is between 3 and 20 mm formed by juxtaposition of elementary spots (6 ) with a diameter between 0.5 and 2 mm.
15. Instrument de traitement selon la revendication 11, 5 caractérisé par le fait que l'unité de commande (49) comporte des15. Processing instrument according to claim 11, 5 characterized in that the control unit (49) comprises
. moyens pour annihiler le balayage séquentiel de tirs laser formant des spots (6) disjoints pour autoriser soit un balayage automatique de spots contigus consécutifs soit un balayage manuel. . means for canceling the sequential scanning of laser shots forming disjointed spots (6) to authorize either an automatic scanning of consecutive contiguous spots or a manual scanning.
PCT/FR1987/000139 1986-04-30 1987-04-24 Systematized treatment instrument, using particularly laser energy, useful for example in dermatology WO1987006478A1 (en)

Priority Applications (2)

Application Number Priority Date Filing Date Title
DE8787902557T DE3781506T2 (en) 1986-04-30 1987-04-24 INSTRUMENT FOR SYSTEMATIC TREATMENT, FOR EXAMPLE IN DERMATOLOGY, ESPECIALLY WITH LASER ENERGY.
AT87902557T ATE80050T1 (en) 1986-04-30 1987-04-24 INSTRUMENT FOR SYSTEMATIC TREATMENTS, FOR EXAMPLE IN DERMATOLOGY, ESPECIALLY WITH LASER ENERGY.

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
FR8606581A FR2598088B1 (en) 1986-04-30 1986-04-30 SYSTEMATIZED TREATMENT INSTRUMENT, IN PARTICULAR USING LASER ENERGY USEFUL FOR EXAMPLE IN DERMATOLOGY
FR86/06581 1986-04-30

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JP (1) JPS63503360A (en)
AT (1) ATE80050T1 (en)
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DE (1) DE3781506T2 (en)
FR (1) FR2598088B1 (en)
WO (1) WO1987006478A1 (en)

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EP0790807A1 (en) * 1994-04-25 1997-08-27 Autonomous Technologies Corporation Laser sculpting method and system
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US5180378A (en) * 1989-04-24 1993-01-19 Abiomed, Inc. Laser surgery system
US5178617A (en) * 1991-07-09 1993-01-12 Laserscope System for controlled distribution of laser dosage
US5474549A (en) * 1991-07-09 1995-12-12 Laserscope Method and system for scanning a laser beam for controlled distribution of laser dosage
EP0710136B1 (en) * 1993-07-21 2004-02-04 Lucid, Inc. Laser treatment system with electronic visualization
EP0710136A1 (en) * 1993-07-21 1996-05-08 Lucid Technologies Inc. Laser treatment system with electronic visualization
US6315773B1 (en) 1994-04-25 2001-11-13 Autonomous Technologies Corporation Eye movement sensing system
EP1108405A2 (en) * 1994-04-25 2001-06-20 Autonomous Technologies Corporation Laser beam delivery and eye tracking system
EP0790807A1 (en) * 1994-04-25 1997-08-27 Autonomous Technologies Corporation Laser sculpting method and system
EP0790807A4 (en) * 1994-04-25 1998-04-29 Autonomous Technologies Corp Laser sculpting method and system
EP0757579A4 (en) * 1994-04-25 1998-08-05 Autonomous Technologies Corp Laser beam delivery and eye tracking system
US5849006A (en) * 1994-04-25 1998-12-15 Autonomous Technologies Corporation Laser sculpting method and system
EP1516605A1 (en) * 1994-04-25 2005-03-23 Alcon Inc. Laser beam delivery and eye tracking system
EP1512379A1 (en) * 1994-04-25 2005-03-09 Alcon Inc. Laser corneal sculpting system
US5980513A (en) * 1994-04-25 1999-11-09 Autonomous Technologies Corp. Laser beam delivery and eye tracking system
WO1995028989A1 (en) * 1994-04-25 1995-11-02 Autonomous Technologies Corporation Laser beam delivery and eye tracking system
EP1060710A2 (en) * 1994-04-25 2000-12-20 Autonomous Technologies Corporation Laser sculpting system
EP1108405A3 (en) * 1994-04-25 2004-01-28 Alcon Inc. Laser beam delivery and eye tracking system
US6261220B1 (en) 1994-04-25 2001-07-17 Autonomous Technologies Corporation Laser sculpting system
EP0757579A1 (en) * 1994-04-25 1997-02-12 Autonomous Technologies Corporation Laser beam delivery and eye tracking system
US6302879B1 (en) 1994-04-25 2001-10-16 Autonomous Technologies Corp. Laser beam delivery and eye tracking system
EP1147753A2 (en) * 1994-04-25 2001-10-24 Autonomous Technologies Corporation Laser beam delivery and eye tracking system
EP1147753A3 (en) * 1994-04-25 2003-11-26 Alcon Inc. Laser beam delivery and eye tracking system
US6451008B1 (en) 1994-04-25 2002-09-17 Alcon, Inc. Laser beam delivery and eye tracking system
US6585726B2 (en) 1994-04-25 2003-07-01 Alcon, Inc. Method of maintaining spacing in an ablation pattern
EP1060710A3 (en) * 1994-04-25 2003-08-20 Alcon Inc. Laser sculpting system
US6626893B2 (en) 1994-04-25 2003-09-30 Alcon, Inc. Method of correcting vision
EP0714642A1 (en) * 1994-11-30 1996-06-05 Laser Industries Limited Method and apparatus for hair transplantation
US6271914B1 (en) 1996-11-25 2001-08-07 Autonomous Technologies Corporation Objective measurement and correction of optical systems using wavefront analysis
US6117129A (en) * 1997-05-30 2000-09-12 Nidek Co., Ltd. Laser treatment apparatus
EP0880940A3 (en) * 1997-05-30 1999-03-10 Nidek Co., Ltd. Laser treatment apparatus
WO1999027996A1 (en) * 1997-12-01 1999-06-10 Lasersight Technologies, Inc. Mutual inlaid method and device for scanning an ablating laser beam

Also Published As

Publication number Publication date
DE3781506D1 (en) 1992-10-08
JPS63503360A (en) 1988-12-08
CA1308171C (en) 1992-09-29
EP0265470B1 (en) 1992-09-02
FR2598088B1 (en) 1991-03-29
FR2598088A1 (en) 1987-11-06
DE3781506T2 (en) 1993-04-08
EP0265470A1 (en) 1988-05-04
ATE80050T1 (en) 1992-09-15

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